Role of tachykininergic and cholinergic pathways in modulating canine gastric tone and compliance in vivo

Influence of a neurokinin-1 receptor antagonist (aprepitant) on gastric sensorimotor function in healthy volunteers

BACKGROUND

Substance P (SP) is a member of the neurokinin (NK) family and is one of the established neurotransmitters in the mammalian central and enteric nervous system. It is unclear whether NK1 receptors are involved in the control of gastric sensorimotor function in man.

METHODS

We studied the effects of aprepitant, an NK1 receptor antagonist used in the treatment of chemotherapy-induced emesis, on gastric sensorimotor function in healthy volunteers. Sixteen healthy volunteers (six males, 32.4 ± 2.7 years) were studied on three separate occasions after placebo, aprepitant 80 or 125 mg in randomized double-blind study to assess gastric compliance, perception to isobaric distensions, and gastric accommodation with a gastric barostat.

KEY RESULTS

Compared to placebo, both doses of aprepitant did not influence gastric compliance or sensitivity to gastric distension. Aprepitant 80 and 125 mg did not have any significant effects on gastric accommodation compared with placebo (mean postprandial gastric volume increase, respectively, 83.4 ± 28.4 vs 35.3 ± 16.2 vs 83.9 ± 30.4 mL, NS). Postprandial gastric compliance and sensitivity to distention were also not altered.

CONCLUSIONS & INFERENCES

In health, NK1 receptors do not appear to be involved in the control of gastric compliance, accommodation or sensitivity to distention in man.

A novel method to assess gastric accommodation and peristaltic motility in conscious rats

OBJECTIVE

To simultaneously study gastric accommodation and peristaltic motility in the whole stomach of conscious rats by measuring intragastric pressure (IGP) during test-meal infusion.

MATERIAL AND METHODS

After an overnight fast, a test-meal infusion system and a catheter to measure IGP were connected to a chronically implanted gastric fistula. IGP was measured during infusion of an X-ray-opaque, non-nutritious viscous test meal (0.25-2 ml min(-1)); gastric motility and emptying were assessed by X-ray fluoroscopy. Peristaltic motility-induced IGP waves were quantified as a motility index (wave amplitude divided by wavelength). Experiments were performed in Sprague-Dawley (SD) rats and in the high-anxiety Wistar Kyoto (WKY) rats. Moreover, the effects of 30 mg kg(-1) NG-nitro-L-arginine methyl ester (L-NAME), 1 mg kg(-1) atropine or 20 mg kg(-1) molsidomine were tested in SD rats.

RESULTS

Compared with SD rats, IGP increased significantly faster during stomach distension in WKY rats, indicating impaired accommodation in the latter strain. Motility indices did not differ between the two strains. L-NAME significantly increased IGP during stomach distension, indicating decreased gastric accommodation. However, no change in motility indices was observed with L-NAME. Treatment with atropine significantly increased IGP and decreased motility indices, indicating decreased gastric accommodation and motility. Molsidomine significantly decreased IGP during stomach distension but did not affect motility. The results correspond to X-ray observations, and confirm literature data.

CONCLUSIONS

We conclude that IGP measurement during test-meal infusion represents an efficient and novel method to compare gastric accommodation and peristaltic motility in the whole stomach of conscious rats.

Defensive and pathological functions of the gastrointestinal NK3 receptor

In general, normal gut functions are unaffected by selective NK(3) receptor antagonists such as talnetant (SB-223412), osanetant (SR 142901) or SB-235375. However, NK(3) receptors may mediate certain defensive or pathological intestinal processes. The precise mechanisms, by which this role is achieved, are not fully understood. In summary, intense stimulation of the intrinsic primary afferent neurones (IPANs) of the enteric nervous system is thought to release tachykinins from these neurones, to induce slow excitation (slow EPSPs) of connecting IPANs. This is hypothesised to cause hypersensitivity and disrupt intestinal motility, at least partly explaining why NK(3) receptor antagonism can reduce the level of disruption caused by supramaximal distension pressures in vitro. Tachykinin release from IPANs may also increase C-fibre sensitivity, directly or indirectly. Thus, NK(3) receptor antagonists can inhibit nociception associated with intestinal distension, in normal animals or after pre-sensitisation by restraint stress. Importantly, such inhibition has been found with SB-235375, a peripherally restricted antagonist. SB-235375 can also reduce a visceromotor response to brief colorectal distension without affecting similar responses to skin pinch, providing additional evidence for intestinal-specific activity. NK(3) receptor biology is, therefore, revealing a novel pathway by which disruptions in intestinal motility and nociception can be induced.

Wistar Kyoto rats have impaired gastric accommodation compared to Sprague Dawley rats due to increased gastric vagal cholinergic tone

OBJECTIVE

Gastric balloon distension shows that, in comparison with Sprague Dawley (SD) rats, Wistar Kyoto (WKY) rats have a decreased volume response owing to a lower accommodation rate. The aim of this study was to compare the role of the vagal cholinergic and nitrergic pathways in the accommodation reflex in these rat strains.

MATERIAL AND METHODS

The volume response to ramp-tonic gastric balloon distension was pharmacologically manipulated by using L-NAME 25 mg/kg i.v., molsidomine 20 mg/kg i.p., atropine 1 mg/kg i.v. and clonidine 0.7 mg/kg s.c.

RESULTS

Following L-NAME, the maximal volume response to distension was significantly decreased in WKY rats (0.74+/-0.11 ml versus 1.18+/-0.13 ml) whereas only a tendency to such a decrease was seen in SD rats. The NO donor molsidomine significantly increased the volume in SD rats (4.91+/-0.46 ml versus 1.81+/-0.50 ml) but only weakly in WKY rats. Atropine significantly increased the gastric volume in WKY rats (2.78+/-0.29 ml versus 1.00+/-0.17 ml) but not in SD rats. Clonidine increased the accommodation rate in the WKY rat, resulting in increased maximal volume (1.69+/-0.26 ml versus 0.65+/-0.11 ml) indicating a reduction in acetylcholine release as a consequence of stimulated presynaptic adrenergic receptors on cholinergic neurons.

CONCLUSIONS

The results indicate that WKY rats may have an increased gastric vagal cholinergic drive, which, during distension, masks the relaxing effect of NO-releasing neurons. The findings in WKY rats could be of relevance for functional dyspeptic patients with impaired gastric accommodation to meals.

Salutary Effects of Tachykinin Receptor Antagonists in a Rat Model of Postoperative Ileus

BACKGROUND

Postoperative ileus (PI) is a common surgical complication treated mainly with supportive measures. Tachykinins control gastrointestinal motility and modulate somatic and visceral pain sensation; therefore, the effect of tachykinin receptor antagonists in a rat model of PI using NK(1-3) antagonists, SR140333, SR48968, and SR142801, was investigated.

MATERIALS AND METHODS

Intestinal transit was measured as Evans blue migration after varied nociceptive stimuli: skin incision (SI), laparotomy (LAP), or laparotomy plus gut manipulation (L + M) in anesthetized rats.

RESULTS

Diethyl ether anesthesia and SI did not influence the intestinal transit of the dye in comparison to untreated animals--UN: 61.17 +/- 5.47, 62.10 +/- 8.30, and 56.70 +/- 4.10 cm, respectively. In contrast LAP and L + M have significantly reduced intestinal motility to 26.40 +/- 2.07 and 9.70 +/- 1.15 cm, respectively. SR140333 (3-30 microg/kg), SR48968 (1-30 microg/kg), and SR142801 (3-10 microg/kg) reversed the additional inhibitory effects of gut manipulation subsequent to LAP dose-dependently, the dye transit returning with the use of the most effective antagonist doses up to 25.28 +/- 1.08, 21.70 +/- 0.19, and 25.0 +/- 1.34 cm. The combinations of submaximal doses of NK(1) and NK(3), NK(2) and NK(3) and NK(1), and NK(2) and NK(3) antagonists were not more effective than a single-agent regimen. On the other hand SR140333 and SR48968 (NK(1) + NK(2) antagonists) acted additively, the intestinal transit reaching 26.60 +/- 0.85 cm. SR140333, SR48968, and SR142801 have not affected the intestinal passage in UN rats or those undergoing SI or LAP.

CONCLUSIONS

SR140333, SR48968, and SR142801 exert a salutary action on suppressed gut motility following surgical manipulation of the gut, the combination of NK(1) and NK(2) antagonists being most beneficial.

Role of NK1 and NK2 receptors in mouse gastric mechanical activity

1. The aim of the present study was to examine the role of NK1 and NK2 receptors in the control of mechanical activity of mouse stomach. In this view, the motor effects induced by NK1 and NK2 receptor agonists and antagonists were analyzed, measuring motility as intraluminal pressure changes in mouse-isolated stomach preparations. In parallel, immunohistochemical studies were performed to identify the location of NK1 and NK2 receptors on myenteric neurons and smooth muscle cells. 2. Substance P (SP) induced biphasic effects: a contraction followed by relaxation; neurokinin A (NKA) and [beta-Ala8]-NKA(4-10), selective agonist of NK2 receptors, evoked concentration-dependent contractions, whereas [Sar9, Met(O2)11]-SP, selective agonist of NK1 receptors, induced concentration-dependent relaxation. 3. SR48968, NK2 receptor antagonist, did not modify the spontaneous activity and reduced the contractile effects induced by tachykinins without affecting the relaxation. SR140333, NK1 receptor antagonist, did not modify the spontaneous activity and antagonized the relaxant response to tachykinins, failing to affect the contractile effects. 4. The relaxation to SP or to [Sar9, Met(O2)11]-SP was abolished by tetrodotoxin (TTX) and significantly reduced by N(omega)-nitro-L-arginine methyl ester (L-NAME). 5. NK2-immunoreactivity (NK2-IR) was seen at the level of the smooth muscle cells of both circular and longitudinal muscle layers. NK1-immunoreactive (NK1-IR) neurons were seen in the myenteric ganglia and NK1/nNOS double labeling revealed that some neurons were both NK1-IR and nNOS-IR. 6. These results suggest that, in mouse stomach, NK1 receptors, causing relaxant responses, are present on nitrergic inhibitory myenteric neurons, whereas NK2 receptors, mediating contractile responses, are present at muscular level.

Rectal distension modulates canine gastric tone and accommodation

Rectal distension affects upper GI myoelectrical activity and motility. The aim of this experiment was to investigate the effect of rectal distension on gastric tone, accommodation, and the underlying mechanism. Seven healthy dogs were surgically prepared and studied. Gastric tone and accommodation were assessed with a barostat. In Experiment 1, the effect of rectal distension on gastric tone and accommodation was evaluated; in Experiment 2, rectal distensions with various volumes were randomly applied and its effects on gastric tone were evaluated; and in Experiment 3, the role of the cholinergic pathway in distension-induced gastric relaxation was assessed. The results showed the following. (1) Rectal distension exerted an inhibitory effect on gastric tone, and this response was distension volume-dependent. (2) Postprandial gastric volume was similar in the control (468.6 +/- 24.7 ml) and the distension study (463.2 +/- 17.5 ml). However, rectal distension increased the preprandial gastric volume, and subsequently decreased the extent of gastric accommodation (139.3 +/- 34.7 ml), which was significantly lower than that of the control (383.2 +/- 26.3 ml; P < 0.001). (3) An intravenous bolus of atropine increased the astric volume from the baseline of 89.4 +/- 12.6 ml to 161.5 +/- 9.8 ml (P < 0.01), and subsequent rectal distension further increased this volume, but the overall change was comparable between the control (297.6 +/- 18.7 ml) and the atropine study (312.1 +/- 21.9 ml; P > 0.05). In conclusion, rectal distension inhibits gastric tone in a volume-dependent manner and impairs gastric accommodation. Atropine dose not block the effect of rectal distension on proximal gastric tone, suggesting that the observed effect may not be mediated by cholinergic pathway.

Neurokinin NK1 and NK3 receptors as targets for drugs to treat gastrointestinal motility disorders and pain

NK1 and NK3 receptors do not appear to play significant roles in normal GI functions, but both may be involved in defensive or pathological processes. NK1 receptor antagonists are antiemetic, operating via vagal sensory and motor systems, so there is a need to study their effects on other gastro-vagal functions thought to play roles in functional bowel disorders. Interactions between NK1 receptors and enteric nonadrenergic, noncholinergic motorneurones suggest a need to explore the role of this receptor in disrupted colonic motility. NK1 receptor antagonism does not exert consistent analgesic activity in humans, but similar studies have not been carried out against pain of GI origin, where NK1 receptors may have additional influences on mucosal inflammatory or "irritant" processes. NK3 receptors mediate certain disruptions of intestinal motility. The activity may be driven by tachykinins released from intrinsic primary afferent neurones (IPANs), which induce slow EPSP activity in connecting IPANs and hence, a degree of hypersensitivity within the enteric nervous system. The same process is also proposed to increase C-fibre sensitivity, either indirectly or directly. Thus, NK3 receptor antagonists inhibit intestinal nociception via a "peripheral" mechanism that may be intestine-specific. Studies with talnetant and other selective NK3 receptor antagonists are, therefore, revealing an exciting and novel pathway by which pathological changes in intestinal motility and nociception can be induced, suggesting a role for NK3 receptor antagonism in irritable bowel syndrome.

Role of 5-HT1B/D receptors in canine gastric accommodation: effect of sumatriptan and 5-HT1B/D receptor antagonists

The 5-HT1B/D receptor agonist sumatriptan has been proposed to treat dyspeptic symptoms, because it facilitates gastric accommodation. It is unknown whether stimulation of 5-HT1B/D receptors is involved. Thus, in four conscious dogs, we compared the effects of sumatriptan alone or combined with N-[4-methoxy-3-(4-methyl-1-piperazinyl) phenyl]-2'-methyl-4'-(5-methyl-1,2,4-oxadiazol-3-yl)-[1,1-biphenyl]-4-carboxamide hydrocloride (GR-127935), N-[3-[3 (dimethylamino)-ethoxy]-4-methoxyphenyl]-2'-[methyl-4'-(5-methyl-1,2,4-oxadiazol-3-yl)]-[1,1-biphenyl]-4-carboxamide hydrocloride (SB-216641 hydrochloride), or 3-[4-(4-chloro-phenyl)piperazin-1-yl]-1,1-diphenyl-2-propanol hydrochloride (BRL-15572 hydrochloride) (respectively, nonselective 5-HT1B/D, selective 5-HT1B, and selective 5-HT1D receptor antagonists) on gastric accommodation to isobaric distensions performed with a barostat. An exponential and a linear model were used to fit the pressure-volume relationship. An exponential equation fitted the data better than a linear equation. Sumatriptan (800 nmol/kg iv) induced an immediate gastric relaxation (Deltavolume: 112 +/- 44 ml, P < 0.05). After sumatriptan, the pressure-volume curve was shifted toward significantly higher volumes. This effect was fully reversed by GR-127935 or SB-216641 but not by BRL-15572. In conclusion, 5-HT1B receptors seem to play an important role in modulating gastric accommodation to a distending stimulus. An exponential model for pressure-volume curves fits well with the concept of gastric adaptive relaxation.